Just over a decade ago, Aine Shaw thought that within a few months she’d be dead. Diagnosed with inoperable lung cancer, she was saved by what seemed at the time like a miracle. In fact, it was a pioneering treatment for cancer that still isn’t as well known or widely available as it deserves to be.

“I’d had asthma and a weak chest for years and had gone into hospital with a bad bout of bronchitis,” says the former casualty nurse from near Buxton, Derbyshire, who is now 71. But an X-ray showed a tumour growing in her left lung.

A team of Canadian and U.S. researchers has developed a new “sharp-shooter” drug they hope may be a breakthrough in treating several types of aggressive cancer.

The drug, known for now as CFI-400945, is a new class of cancer agent that targets an enzyme involved in some malignancies, among them certain types of breast cancer, and ovarian, colorectal, pancreatic and prostate cancers.

“Normally it would have been removed,” she adds. “But my lungs were in such a bad way from the asthma and bronchitis that the surgeon said I probably wouldn’t survive the anesthetic, so they weren’t going to operate.”

She remembers being given only a short time to live. “I left hospital to go home and say goodbye to my family. I was in a terrible state. My husband, David, was devastated and so were my two daughters. I had so wanted to see my three grandchildren [Lucy, now 18, Alex, 20, and Lauren, 22] grow up.”

Then, a surgeon at the Christie Hospital in Manchester, where Aine had been seen, told her about a little-known treatment that could destroy some tumours without surgery. Photodynamic Therapy (PDT) involves a special kind of drug called a photosensitizer. Once in the body’s cells, the drug reacts to light by producing a highly destructive form of oxygen (known as singlet oxygen) that can destroy a tumour with a single exposure. There are different types of sensitizing drugs and each is activated by the light of a different wavelength.

‘I had two treatments three months apart, but then the tumour was gone and it’s never come back’

The drug is swallowed or injected; the two most common brands are Foscan and Photofrin. The patient then waits for a few hours or days, depending on the brand, for the drug to be absorbed by all the cells in the body, including the cancerous ones, which can then be destroyed by light.For internal tumours such as the one that was in Aine’s lung, an endoscope, with a fine fibre-optic cable attached, is passed down the throat to focus a powerful laser beam precisely on the tumour. It can be done as an outpatient procedure, with the patient sedated, and takes about an hour.

Aine was treated by Professor Keyvan Moghissi, one of the pioneers of PDT in the U.K., at the Yorkshire Laser Centre, a charitable trust he set up in 1984. The centre now has a partnership agreement to provide PDT through Northern Lincolnshire and Goole Hospitals Trust.

“I had two treatments three months apart, but then the tumour was gone and it’s never come back,” she says. “I couldn’t believe it was so easy. There was no pain and I was back to normal in a few days.” After each treatment, Aine had to stay out of the sun for a couple of months — exposure so soon can result in nasty blistering.

Aine had her last check-up with Professor Moghissi about a year ago. “I’ve tested her twice a year for the past 10 years, but there has been no sign of a recurrence,” he says. “We had two things to celebrate. She was still alive – and she is now a great-grandmother [to Harvey, four].”

In Aine’s view, everyone should know about PDT. “What’s shocking is that most people still don’t,” she says.

Some specialists are frustrated that such a cheap and effective treatment, which has none of the gruelling side effects of chemotherapy, is still not an automatic option for patients who might benefit. At the moment, PDT is approved by the National Institute for Health and Care Excellence (Nice) in Britain for four cancers – those of the skin (but not the most lethal type, melanoma), and early or late cancers of the head and neck, lung or oesophagus. Other areas such as prostate and brain may be added in the future, if trials currently underway turn out to be successful. (The type of PDT approved by Nice is not the same as certain other forms offered by some private clinics. The Department of Health has issued a warning about these treatments, called “next-generation PDT” (NGPDT) or “sonodynamic therapy” (SDT), saying their efficacy is not supported by evidence.)

Small early cancers are thought to respond well to PDT, while it is also useful for “debulking” large tumours blocking something vital like a windpipe; or as a last resort when other treatments have failed. In all of these areas, PDT can, in some cases, save suitable patients from disfiguring surgery and damaging radiation.

He argues PDT should be used as a first-line treatment for early lung cancer

Yet clinicians who use PDT say it is not used as widely or as often as it could be. It could benefit many more patients like Aine, Prof Moghissi claims. “There are about 4,000 such cases annually,” he says. “At the moment, most of these patients have surgery to remove the tumour, and a few – who are too weak or, like Aine, have an inoperable cancer – may get PDT. It is only used as a last resort.”

But, he argues, PDT should be used as a first-line treatment for early lung cancer. This already happens in Japan, where the survival rates are the same as for surgery. “PDT is minimally invasive; it doesn’t destroy the underlying tissue and if necessary it can be repeated. That’s important if you are treating sensitive areas like the lung or head and neck.”

So with all this going for it, why is PDT still one of cancer’s best-kept secrets? Despite having been around for 30 years and having a number of enthusiastic supporters, critics say there still aren’t enough scientific studies testing it against standard treatments. Cancer Research UK warns that caution is needed. “Compared to other treatments, overall the evidence for PDT is relatively patchy. There’s much more work to do,” it says.

An evaluation of PDT at the University of York in 2010 concluded that, as yet, good quality trials were lacking, though the treatment appeared promising.

This battle over evidence has dogged a review of the effectiveness of PDT, commissioned in 2008 by Prof Sir Mike Richards, then the National Clinical Director for Cancer (and currently the first chief inspector of NHS hospitals). Prof Richards promised that if PDT “turns out to offer a better deal than existing treatments, it should soon be available right across the country”. The review, which he expected to report the following year, is still ongoing. According to one academic, some experts remain sceptical and are demanding large-scale randomized trials before they will accept its widespread use. Until then, patients who might benefit must wait.